It was after midnight, and Dawn Jacques lay sleepless in her cell at the Adult Correctional Institutions, shuddering. Bathed in sweat, she stared at the ceiling for hours until it blurred. When the occasional wave of nausea ran through her, she lurched toward the toilet, vomiting.

It could have been the first time she was incarcerated or the tenth. Jacques, a 31-year-old from Cranston, has been addicted to heroin and in and out of jail for 10 years, and the long nights of withdrawal were the same every time.

“It felt like I was going to die,” Jacques says. Jail made her feel “miserable,” she says, “like [she] had no choice but to keep using.” And upon leaving prison, that’s exactly what she would do: return to the streets and start shooting up again.

Across the state, Jacques’s story is a familiar one. America’s drug war has devolved into a domestic quagmire, costing $500 billion without discernible success. Yet while a wealth of studies indicate that treating addicts is more cost-effective than incarcerating them, access to treatment remains limited in many states, including Rhode Island. In fact, according to data from the US Substance Abuse and Mental Health Services Administration, Rhode Island has the second-highest rate of addicts that need treatment but don’t receive it.

Not surprisingly, the state prison system is feeling the crush. Since 1976, the ACI’s population has exploded by 457 percent, with what Department of Corrections Director A.T. Wall calls an “ever-increasing number of offenders with substance abuse problems being swept [in]” — and with similar cost increases for the state. Today, 70 percent of ACI inmates report substance abuse problems (mostly heroin, alcohol, and cocaine). And without treatment, the majority of these offenders who are released will end up imprisoned again.

With Rhode Island beset by a $151 million budget shortfall, several proposals to shrink the prison population are being aired with greater urgency, including parole reform, reducing court debt-related incarceration, and conditional sentence reduction. To date, however, efforts to make treatment a legislative focus have stalled, and the outlook for a dramatic change seems bleak. Earlier this year, for example, the House adopted a proposal that allows prisoners to earn time off for good behavior — but only after stripping the provision that would have similarly allowed inmates time off for participation in rehabilitative programs.

While Wall believes that greater access to treatment might reduce the ACI’s population, changing the situation is proving extremely difficult, because of the state’s budget problems and since doing so goes against the ingrained way of dealing with drug-related crime.

The heroin-crime connection

Thanks to an influx of South American heroin, the drug is cheaper and more potent than ever, says Lieutenant Thomas Verdi, who heads the narcotics unit of the Providence Police Department. A bag of heroin costs as little as $5: less than a six-pack of beer and enough to stay high for several hours.